What are the red flags for dental pain & abscess in urgent care?

Floor-of-mouth swelling, raised tongue, drooling, difficulty swallowing or breathing → Ludwig’s angina — airway emergency, ED/maxfax; Trismus, swelling spreading to the eye or neck → Spreading infection — maxfax same day; Systemically unwell / sepsis → Admit, IV antibiotics; Uncontrolled bleeding after extraction → Pressure with gauze 20 min; dental/maxfax

What should I prescribe for dental pain & abscess?

Ibuprofen: 400 mg four times a day with food (Up to 5 days (with paracetamol if needed)); Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Antibiotics only if spreading infection or systemic features: phenoxymethylpenicillin: 500 mg four times a day (or amoxicillin 500 mg three times a day) (Up to 5 days, plus urgent dental drainage); Penicillin allergy: metronidazole: 400 mg three times a day (Up to 5 days (no alcohol))

Dental Pain & Dental Abscess in Urgent Care | Urgent Care Clinic

Q: What safety-netting advice should I give for dental pain & abscess?

Advise the patient to return or seek help if: Swelling under the tongue or in the neck, difficulty swallowing or breathing — call 999; Swelling spreading towards the eye, or can’t open your mouth; Fever or feeling very unwell.

1Rule out first — red flags

If you find…	…then
Floor-of-mouth swelling, raised tongue, drooling, difficulty swallowing or breathing	Ludwig’s angina — airway emergency, ED/maxfax
Trismus, swelling spreading to the eye or neck	Spreading infection — maxfax same day
Systemically unwell / sepsis	Admit, IV antibiotics
Uncontrolled bleeding after extraction	Pressure with gauze 20 min; dental/maxfax

2Focused history

Tooth, duration, pain character
Swelling, fever, trismus, swallowing, breathing
Registered dentist? Recent dental treatment
Allergies, anticoagulants

3Focused examination

Obs
Facial swelling, lymph nodes
Mouth opening (trismus), floor of mouth, tongue position
Tooth tenderness, gum swelling

4Decide — investigate only if it changes the plan

Investigation	Only if…
None	Dental X-rays are done by the dentist

5Treat & send home

Management & advice

Definitive treatment is dental (drainage / extraction / root canal) — antibiotics don’t fix toothache
Urgent dental care: their dentist, or NHS 111 for urgent dental services
Salt-water mouthwashes; avoid very hot/cold food

Refer / follow-up

Spreading facial swelling, trismus, airway → maxfax / ED

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Ibuprofen	400 mg four times a day with food	Up to 5 days (with paracetamol if needed)
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Antibiotics only if spreading infection or systemic features: phenoxymethylpenicillin	500 mg four times a day (or amoxicillin 500 mg three times a day)	Up to 5 days, plus urgent dental drainage
Penicillin allergy: metronidazole	400 mg three times a day	Up to 5 days (no alcohol)

6Safety-net

Say it like this

The pain is coming from the tooth, and the fix is with a dentist. Antibiotics don’t cure toothache. Take ibuprofen and paracetamol regularly and contact your dentist, or NHS 111 for an urgent dentist, today or tomorrow. If you get swelling under your tongue or in your neck, or trouble swallowing or breathing, call 999.

Come back / call 111 — or 999 if severe — if:

Swelling under the tongue or in the neck, difficulty swallowing or breathing — call 999
Swelling spreading towards the eye, or can’t open your mouth
Fever or feeling very unwell

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Toothachenhs.uk/conditions/toothache

Dental abscessnhs.uk/conditions/dental-abscess

8Document

Dental pain & abscess — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — DENTAL PAIN & ABSCESS PRESENTING COMPLAINT: HISTORY Tooth, duration, pain character: Swelling, fever, trismus, swallowing, breathing: Registered dentist? Recent dental treatment: Allergies, anticoagulants: RED FLAGS (record present / absent) [ ] Floor-of-mouth swelling, raised tongue, drooling, difficulty swallowing or breathing [ ] Trismus, swelling spreading to the eye or neck [ ] Systemically unwell / sepsis [ ] Uncontrolled bleeding after extraction PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Obs: Facial swelling, lymph nodes: Mouth opening (trismus), floor of mouth, tongue position: Tooth tenderness, gum swelling: INVESTIGATIONS: none required / None — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Toothache, Dental abscess Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Swelling under the tongue or in the neck, difficulty swallowing or breathing — call 999 - Swelling spreading towards the eye, or can’t open your mouth - Fever or feeling very unwell Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More ear, nose, throat & eyes

Sore throat & tonsillitisFeverPAIN decides — and don’t miss the quinsy or epiglottitis.Earache: otitis media & externaMostly no antibiotics — but spot mastoiditis and malignant otitis externa.SinusitisViral until day 10 — and don’t miss the orbit.Nosebleed (epistaxis)Proper first aid, cautery if you can see it, and who needs ENT.